title: Neonatal blood pressure monitoring: visual assessment is an unreliable method for selecting cuff sizes.
abstract: OBJECTIVE
  To compare current practice of cuff size selection for noninvasive blood pressure measurement in a single-centre, tertiary-level neonatal intensive care unit (visual assessment of bladder width/limb length closest to 2/3) with common recommendations for appropriate cuff selection.
  
  
  METHODS
  Visual assessment of the appropriate cuff size ('2/3 rule') for upper arm, forearm and calf in 103 neonates (309 cuff selections) was compared with the following recommendations: (i) Method A - guidelines of the cuff manufacturer, (ii) Method B - cuff width/limb circumference ratio 0.44-0.60 and (iii) Method C - cuff width/limb length ratio closest to 0.66.
  
  
  RESULTS
  The upper arm cuff size was correctly chosen in 84% of cases (Method A), 43% (Method B) and 56% (Method C). The forearm cuff size was correctly chosen in 94% of cases (Method A), 68% (Method B) and 54% (Method C). The calf cuff size was correctly chosen in 96% of cases (Method A), 72% (Method B) and 63% (Method C).
  
  
  CONCLUSIONS
  The accuracy of selecting cuff size by visual assessment is low. Further research on accurate cuff selection for neonates, including at the forearm and calf, is warranted.
authors.affiliation: Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
authors.forename: A
authors.initials: A
authors.lastname: Devinck
authors.forename: H
authors.initials: H
authors.lastname: Keukelier
authors.forename: I
authors.initials: I
authors.lastname: De Savoye
authors.forename: L
authors.initials: L
authors.lastname: Desmet
authors.forename: K
authors.initials: K
authors.lastname: Smets
mesh_terms: D001132:Arm / Q000033:anatomy & histology; D001795:Blood Pressure Determination / Q000295:instrumentation / Q000592:standards; D006801:Humans; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal / Q000379:methods* / Q000592:standards; D017410:Practice Guidelines as Topic; D019722:Sphygmomanometers / Q000592:standards
keywords: Blood pressure measurement; Newborn; Noninvasive; Oscillometric method